Provider Demographics
NPI:1093871964
Name:STURM, JILL A (LCSW-C)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:A
Last Name:STURM
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6618 STIRRUP CT
Mailing Address - Street 2:
Mailing Address - City:SYKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21784-5949
Mailing Address - Country:US
Mailing Address - Phone:410-245-4521
Mailing Address - Fax:410-876-3016
Practice Address - Street 1:6618 STIRRUP CT
Practice Address - Street 2:
Practice Address - City:SYKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21784-5949
Practice Address - Country:US
Practice Address - Phone:410-245-4521
Practice Address - Fax:410-876-3016
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD079901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD615501400Medicaid